PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| Survey date | phq_date | N | text | - | - | - | |
| a. Little interest or pleasure in doing things | phq9_1a | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | 1. Over the <u>last 2 weeks</u> how often have you been bothered by any of the following problems? <i>(Click the circle to indicate your answer)</u> | |
| b. Feeling down, depressed, or hopeless | phq9_1b | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | - | |
| c. Trouble falling or staying asleep, or sleeping too much | phq9_1c | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | - | |
| d. Feeling tired or having little energy | phq9_1d | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | - | |
| e. Poor appetite or overeating | phq9_1e | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | - | |
| f. Feeling bad about yourself -- or that you are a failure or have let yourself or your family down | phq9_1f | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | - | |
| g. Trouble concentrating on things, such as reading the newspaper or watching television | phq9_1g | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | - | |
| h. Moving or speaking so slowly that other people could have noticed? Or the opposite -- being so fidgety or restless that you have been moving around a lot more than usual | phq9_1h | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | - | |
| i. Thoughts that you would be better off dead or of hurting yourself in some way | phq9_1i | N | radio | 0, 0- Not at all | 1, 1- Several days | 2, 2- More than half the days | 3, 3- Nearly every day | - | - | |
| 2. If you checked off <u>any</u> problems, how <u>difficult </u> have these problems made it for you to do your work, take care of things at home, or get along with other people? | phq9_2 | N | radio | 1, 1- Not difficult at all | 2, 2- Somewhat difficult | 3, 3- Very difficult | 4, 4- Extremely difficult | - | - | |
| 3. How many days did you take your psychiatric medication(s) over the past 2 months? Enter number of days (0-60). 0, if not prescribed meds. | phq9_3 | N | text | - | - | Adherence | |
| 4. Are you having any side effects from your psychiatric medication? | phq9_4 | N | radio | 0, 0-not applicable or just starting treatment | 1, 1-no side effects | 2, 2-mild or trivial side effects | 3, 3-bothersome, but tolerable side effects | 4, 4-very bothersome side effects, thinking about stopping medication | 5, 5-severe enough side effects that I did stop taking the medication | - | - | |
| 5. Which of the following best describes your current employment status? | phq9_5 | N | radio | 0, 1- Employed full or part-time | 1, 2- Unemployed | 2, 3- Fully disable or unable to work | 3, 4- Homemaker or student or retired | - | - | |
| 6. Because of the way you felt, or any health problems, how many days of work did you miss in the last month? | phq9_6 | N | text | - | - | - | |
| 7. Now think about your productivity in the last 2 months when you were at work, what percentage were you able to perform your daily activities effectively, where 100 is your best and 0 is not being able to do anything? | phq9_7 | N | text | - | 0-100 | - | |
| 8. In the past 60 days, have you made any attempts to harm yourself? | phq9_8 | N | yesno | - | - | - | |
| 9a. Total number of visits | phq9_9visits | N | text | - | Total visits | 9. How many visits to the Emergency Room and/or nights in the hospital have you had, for any psychiatric reason, in the last 60 days? | |
| 9b. Total number of nights | phq9_9nights | N | text | - | Total nights | - | |
| 10. To what extent has your psychiatric treatment met your needs?_x000D_ _x000D_ If you do not have psychiatric needs, skip this question._x000D_ | phq9_10 | N | radio | 0, 1-Almost all of my needs have been met | 1, 2-Most of my needs have been met | 2, 3-Some of my needs have been met | 3, 4-Only a few of my needs have been met | 4, 5-None of my needs have been met | - | - | |
| 11. How confident are you that you can do the things necessary to manage your emotional health on a regular basis? | phq9_11 | N | radio | 0, 1-Not confident | 1, 2-Somewhat confident | 2, 3-Very confident | - | Additional Questions | |
| Notes | phq9_notes | Y | notes | - | - | - |